Futuring Paper – Health Sciences and Public Health

Co-Conveners: Mary Gallant (Health Policy, Management & Behavior) and Ben Szaro (Biological Sciences)

The ideas summarized in this futuring paper arose from a group discussion of these questions, as well as from written responses submitted electronically from the UAlbany community. In all 25 individuals participated in this effort.

  1. What forces are shaping the disciplines of Health Sciences and Public Health today, including those related to learning, work, and professional practice?

    • Increased attention to public health and the population health paradigm, and a growing number of educational programs in public health
    • There have been dramatic increases in the number of schools and programs of public health, with even more schools and MPH programs on the horizon. Currently there are 59 accredited schools of public health (almost double the number from ten years ago) and 109 accredited MPH programs. In addition, there are 59 schools and programs in the process of seeking accreditation. There is also a growing interest in and a growing number of undergraduate public health degree programs; public health is one of the fastest growing undergraduate majors nationally.

    • Demand among undergraduates for health science training
    • Due to growth in the health care industry, students perceive that this is where the jobs of the future will be. This perception has placed tremendous pressure on institutions of higher education to offer training in the health sciences to prepare steadily increasing numbers of students for careers in the health care industry. Such education is at odds with the skills and interests of the faculty of traditional research university departments, which currently comprise scientists mainly interested in advancing research. These faculty are now being asked to provide knowledge-based training for this new, growing class of students. Such students, who now number well over a thousand at the University at Albany, are generally less interested in learning the skills to do research than in simply learning what they need to know to prepare them for jobs in health care delivery.

    • Health system transformation (not just healthcare)
    • The health system is in the midst of a vast transformation. Increasing quality of care while decreasing costs is center stage, and there’s a growing emphasis on integrating population health into healthcare. Health care cost is forcing a shift in emphasis from treatment to prevention. Improvements in quality are going to be increasingly dependent on the ability to work with diverse populations. There are nursing and primary care provider shortages, and a growing role for other types of health care professionals in health care delivery. Nationally, there is a push toward interprofessional education.  Electronic medical records will mean a greater availability of health-related data. Mental health/behavioral health is becoming more integrated into traditional medical care. Within the context of national and state health care reform (insurance coverage, changing structure and financing for health care service delivery), there is a growing challenge to "make the case" for public health in the context of a heightened focus on insurance and preventive clinical services.

    • Increased emphasis on interdisciplinary work
    • Research in the health sciences is increasingly demanding that scientists integrate both information and research skills across scientific disciplines that traditionally resided in multiple academic departments, often found in separate schools and colleges. Already, the past few decades witnessed an integration of the skills of biochemists and structural molecular biologists with those working in all areas of the life sciences, bringing the power of molecular genetics to bear across the discipline.
      Within education in the health sciences and public health, there is also increasing emphasis on interdisciplinary and transdisciplinary work, and interprofessional education.

    • System-based paradigm (vs atomistic) and systems thinking
    • There is a movement toward systems thinking throughout public health and the health sciences. This includes the system-based “-omics” paradigm (e.g. genome, proteome, microbiome, exposome, metabolome, lipidome, epigenome, metagenomics, pharmacogenomics), as well as an emphasis on systems thinking in the delivery and organization of public health and health care services. 

    • Advances in genomic DNA sequencing
    • These advances translate into the ability to sequence bacteria, viruses, and individual genes. As the cost of sequencing decreases, there may be a point at which sequencing the entire genome is the answer. This will be a driver of change in the way we study outbreaks. In addition, the development of new technologies such as next generation sequencing will lead to point of care diagnostics.

    • Increasing availability of health-related data
    • We are witnessing a data explosion across almost every discipline.  For example, there is increasing availability of data for research from providers due to the Affordable Care Act. Advances in DNA sequencing are leading to increasing amounts of data, as are the systems-based paradigms described above.

    • Increasing reliance on information technology
    • There is increased reliance on information technology for both education and practice.  Online education and telemedicine are just two examples.

    • Globalization and climate change
    • These forces are leading to emerging infections and rapid transmission of disease.  Health diplomacy is increasingly important. Emerging and re-emerging infections highlight the importance of surveillance and vaccine availability and production.
    • Social justice and health equity
    • The racial tensions we are witnessing in society highlight the importance of addressing social justice and health equity, and emphasize the importance of community engagement and involvement.

    • Workforce transitions in public health
    • A demographic transition is occurring in the public health workforce as a significiant proportion of the workforce nears retirement. As the leadership changes, we will experience a mass exodus in institutional knowledge.

    • Lack of research literacy and explosion of information
    • Researchers, practicing professionals, community activists, and community members don't speak a common language in regards to scientific evidence, and researchers don’t know how to translate research findings for diverse audiences. At the same time there is an explosion of available information, leading to more confirmational bias. 

    • More competition for decreasing research funding
    • We are experiencing what seems to be a long-term lack of societal support and funding for health science and public health research and funding for prevention.

    • Dramatic demographic changes in the population
    • Major changes are occurring in family structure and in the racial/ethnic composition of U.S. The aging of the population means that soon over 20% of the population will be above age 65. The major shifts in population demographics will require a more diverse and culturally competent workforce.  The 'browning of America' must be reflected at every level to adequately prepare the future workforce.

    • Changing communities
    • Gentrification in urban areas may improve the fiscal and physical landscapes, but has had a negative impact in our cities.  Urban dwellers have been displaced, only to be relocated to other less than desirable locations and victims of municipal economic deprivation. Rural communities are struggling just to be part of any strategic and meaningful community development and youthful flight from these areas due to lack of opportunities, compounds their problems. In too many cases, both of these communities are being populated with older and poorer residents.

    • Increased awareness of environmental exposures at the community level and how environmental and social factors interact to influence public health

  2. In ten years, what forces will shape changes in the disciplines of Health Sciences and Public Health?  How will professional practice be affected?
  3. We see the current forces described above as continuing to exist ten years from now.  In addition, we envision these forces:

    • Genomics, at both the personal and population levels, will be a bigger factor in managing disease. Tomorrow's public health professionals should have an understanding of genetics to be prepared for an increasing role of genomics on health care distribution.

    • Greater amounts of data, emphasis on informatics and data analytics and a focus on large databases and cohorts to frame research and interventions. There will be increasing opportunities for data mining and analysis, inter-disciplinary studies and analysis of data banks.

    • More technological innovations for improving public health, particularly in analytics and data science; more streamlined and universal data pipelines for data sharing; more user-friendly bioinformatics software; rational data storage policies

    • Changes in technology and medicine will change public health and the health sciences. Practice will likely change in ways we can’t even imagine now (i.e., use of virtual reality tools). There will be more automated processes due to machine learning, robotics and other high tech developments, and more patient involvement in health care delivery.  Changes in technology will impact how we teach and learn, how we implement interventions, and how we conduct research.  For example, in attempts to improve community health, Washington, DC and other cities have started to issue cell phones to residents in low-income residents to remind them of the importance of keeping well-baby clinic and chronic disease management appointments.We’ll likely see more such integration of technology in the future.

    • There will be continued integration of disciplines.  Health scientists will need to be skilled at integrating even these relatively molecular genetic skills with additional skills of computer scientists and mathematicians for analyzing large data sets being generated by high throughput sequencing, as well as with skills of physicists and engineers to build new devices, both for expanding the frontiers of investigation and for translating discoveries into applications. Practitioners need to have working knowledge and skills across many disciplines some of which are beyond the traditional scope of public health (e.g., mental health).

    • Greater integration of clinical medicine and public health, but also a tension between personal and public health due to the growth of personalized medicine

    • There will be new and emerging technologies in education, such as online learning, virtual reality, moocs, and yet-to-be developed technologies.

    • Continuedevolution of health care reform and health care financing models

    • Increasingdiversity of students, patients, workforce, and communities and continued health disparities

    • Need for structural competency, not just cultural competency
    • Crumblinglocal infrastructure for public health, and lack of resources at local levels to incorporate technology advances

    • Emphasis on quality improvement, return on investment, and evidence-based practice

    • Need for justification of activities in government
    • The political climate will continue to shape these disciplines, but the implications of this are uncertain

    • Climate change will also increasingly impact public health with respect to both infectious and chronic diseases.

    • The development of simpler, field deployable sequencers and testing devices capable of more sophisticated testing

    • More global and interdisciplinary collaboration

    • External factors, such as terrorism, gun violence, and emerging infections, may be prioritized over chronic disease prevention. 

    • New epidemics and drug resistance will have implications for how we treat infectious disease

    • Changes in how the Millennial generation is prioritizing work/life, and in the way that "work" is defined by these newest generations will impact the disciplines.

    • A quickening pace with which evidence need to be in the hands of practitioners

    • Increasing emphasis on occupational health particularly in the developing world where the distinction between occupational and environmental becomes blurred.

    • A shift towards prevention through lifestyle adjustments including nutrition, exercise, stress management and overall mental balance.  Public health professionals need to be aware of these trends and promote the lifestyle adaptations that are backed by scientific evidence.

  4. What are the implications for the Health Sciences and Public Health professions, continuous professional development, and teaching and learning? Specifically, what new opportunities may be created in the future?

    • There will be a need for skills in the management and analysis of large datasets, informatics, data analytics, and data security

    • Technology and related advancements will have a significant impact on the various health science disciplines and public health. For example, increasing amounts of data, information, and analytics has the potential to facilitate quick identification of outbreaks and those most at risk, and to rapidly deploy resources. Hurricane Katrina and other natural disasters have demonstrated the importance of these factors.

    • We need to be ready to withstand increased competition among the growing number of schools of public health for graduate students, and increased competition among universities in general for students interested in the health sciences.  Also, as the number of undergraduates and graduates trained in public health increases, we need to give our students a competitive advantage in what will be an increasingly competitive job market.  We need to define the niches that we see our health science and public health programs filling in the future. UAlbany has an opportunity to enhance the emphasis on practice-based education that already is a key feature of our School of Public Health, and stems from our partnership with the NYS Department of Health.  This will enhance our ability to compete successfully for students and will enhance our students’ readiness to enter the job market as highly skilled professionals.

    • Courses in systems thinking and leadership will be important for all students and practitioners.

    • Rather than emphasizing “interdisciplinary” collaboration among scientists from different disciplines, a new emphasis must be placed on “integration”. Health scientists intent on making real progress must learn to speak the language of mathematicians, physicists, chemists, and engineers while retaining the ability to think like a biologist.  Public health will need an ever increasingly broad exposure to other disciplines that influence public health and healthcare policy. There will be a need for students to be able to access faculty with expertise across the disciplines that impact public health and health sciences.

    • Researchers will need to know how to translate evidence for multiple and diverse audiences and practitioners will need to know what science to communicate.  There will also be a need for practitioners who are well versed in promoting health and social equity as key components of community development.

    • Undergraduate students are much more racially/ethnically diverse than current graduate students/faculty - and much more likely to represent communities in which PH professionals needs to work.  Greater and more aggressive efforts to recruit, mentor, graduate and maintain students and faculty-members of color are critical to improving population health. Curricular changes are necessary to foster meaningful learning and discussions of the historical impact of race, culture, ethnicity, gender preferences in our society. Such courses should be fully integrated into the fields of study.

    • Existing practitioners will need continuing education and training and more resources need to be directed toward post-graduation/post-degree education. We will need to develop more tailored, on-demand offerings for continuing professional development for practitioners.

    • Without boldly addressing race, social justice and equality, we will miss opportunities to deal with the underlying complications to improve health outcomes.  Advances in technology will give providers the tools to treat a variety of diseases and illnesses. But, prevention must begin with understanding why some communities are generationally sicker than others. An examination of those social determinants and resources to explore other intervention options is essential. Concepts related to community development, with emphasis on urban and rural underserved populations must receive greater attention.

    • In addition to the continuing need in this country there is a tremendous need for workplace health globally.  The International Labor Organization reports more than 2 million deaths each year from occupational disease.  In addition, about 160 million of the world's workers get sick every year due to non-fatal occupational diseases.  More people die each year from Occupational disease than from other better-recognized hazards like HIV/AIDS, armed conflict and road crashes. People need to understand traditional industrial processes, for example, mining, forestry, fishing, welding and manufacturing, as well as emerging technologies such as nanotechnology and robotics.

  5. How will future developments and opportunities affect the university?  What departments or units might be impacted? How might UAlbany respond to these within the strategic planning process?

    • UAlbany needs to integrate the health sciences disciplines on campus to provide students and faculty ready access to one another if they expect to build real collaborative teams successfully. Scientists in the Chemistry, Physics, Psychology, and Biology Departments of U Albany have already voiced an interest in moving in this direction, as they have proposed and begun initiatives in neuroscience, regenerative medicine and developmental biology, RNA science, and biological engineering. To achieve this integration while maintaining the structure of traditional departments necessary for undergraduate education, the University may have to reconsider its current separation of the basic sciences, which still play a primary role in advancing research in the health sciences, from the applied sciences. In addition, there should be more opportunities for collaborative research and assistance with negotiating cross-border agreements for global research initiatives.

    • The needs of training research scientists must still remain somehow connected to the offerings of a liberal arts education. Young scientists in training must receive education in the humanities in order to develop an appreciation of the historical and societal implications of all this new technology. Similarly, students outside STEM must nonetheless understand enough about technology to be responsible users, consumers, and administrators of it. These are difficult challenges, given the tendency of academics to silo themselves into fiefdoms. Nevertheless, the University at Albany has the advantage that we are still in the nascent stages of growth in the health sciences, and therefore have an opportunity to proceed wisely with appropriate strategic planning.

    • The student pipelines needs to be moved “back”. Traditional majors need rethinking and undergraduates need to be taught many of these “new” things sooner.  All undergraduates need some basic exposure to public health and health sciences to be part of an informed society.

    • To respond to the need for interdisplinarity, the university should consider changes in curriculum, changes in departmental structures away from the traditional disciplinary structure, and more case-based and team-based teaching. Curriculum changes should reflect interdisciplinary studies. For example, we will need scientists that are: (1) knowledgeable in new technologies and their applications; (2) scientists and health professionals with a business sense; (3) patent lawyers with a sense of public health and health sciences, and (4) clinical microbiologists and broader access to ABMM programs.

    • There needs to be an increased emphasis on enhancing communication across the university and on increasing communication skills among students. This is important for cross-disciplinary work, for cross cultural work, and to bridge terminology differences across fields.

    • The School of Public Health will be impacted; departments that traditionally focus on soft skills such as management will need to work with more hard science/technology departments for new research/educational initiatives.  New types of positions or department structures that help build bridges across fields should be considered.

    • It is also imperative that our School of Public Health defines its niche to retain a competitive advantage in attracting students.  One of our SPH's strengths is our collaborative relationship with NYSDOH, and we need to strengthen the relationship.  The link with DOH will be of increasing importance for laboratory science, big data, and health system transformation.

    • Expansion of the Health Sciences Campus may mean more visibility and presence of external entities (i.e. politicians) interested in developing the location's economic opportunities, and may spur revitalization but also impact traffic and inter-campus transportation needs and opportunities, and risk overshadowing public health.

    • We should strive for more collaboration with local governments and other state agencies on community-based health initiatives and more local community-based participatory research, and build more infrastructure to support flexible community engagement work that is responsive to emerging threats. Partnerships will also be increasingly important, and programs could build partnerships with CDC, USDA, FDA, and APHL, for example.

    • The Center for Public Health Continuing Education will continue to be a vibrant part of the educational picture. We need to tailor education to the various unique professions within the public health workforce, not just a "generic" and build the infrastructure so that continuing education can be provided to greater numbers. Given the rapidly changes in these disciplines, the university should also consider how to invest in continuing education for faculty in order to increase their skills in new and developing areas.

    • We need to find ways to build institutional infrastructure and individual skills to manage big data and incorporate new statistical methods. UAlbany should identify existing or new degree programs to emphasize bioinformatics and big data analysis.
    • We need infrastructure that recognizes the need to collect biologic samples and collect and store data.

    • Enhance opportunities for collaborative work with medical, law and pharmacy schools.

    • Students will need to be proficient in new technologies and the university needs to invest in new technologies to keep pace with the changing face of these disciplines.

    • UAlbany should consider developing advisory boards of scientists in the fields in order to become nimble as to what is the future of the health science and public health fields.

    • Pursue linkages (or directly incorporate in our degree offerings) companion certifications to add a specific practical dimension to academic public health training (e.g. health teacher certification, project management certification, quality improvement skills, certified health care education (e.g. diabetes educators, lactations consultants, etc).

    Establish more formal health career counseling tailored to students with population health interests, and potentially pursue formal pathways with other health care professions including and beyond medicine (nursing, physician assistant, midwifery). Pathways with nursing may be especially attractive as nurses represent the largest segment of the professional health care workforce, and the public